Overview of the cholinergic contribution to gait, balance and falls in Parkinson's disease

Rosie Morris, Douglas N. Martini, Tara Madhyastha, Valerie E. Kelly, Thomas J. Grabowski, John Nutt, Fay Horak

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations


Mobility deficits, including gait disturbance, balance impairments and falls, are common features of Parkinson's disease (PD) that negatively impact quality of life. Mobility deficits respond poorly to dopaminergic medications, indicating a role for additional neurotransmitters. Due to the critical role of cortical input to gait and balance, acetylcholine—an essential neurotransmitter system for attention—has become an area of interest for mobility. This review aimed to identify the role of cholinergic function on gait, balance, and falls in PD using three techniques; pharmacological, imaging, and electrophysiological. Studies supported the role of the cholinergic system for mobility in PD, with the most promising evidence indicating a role in falls. Imaging studies demonstrated involvement of anterior cholinergic (basal forebrain) systems in gait, and posterior (brainstem) systems in balance. However, this review identified a small number of studies which used varying protocols, making comparisons difficult. Further studies are warranted, measuring comprehensive gait and balance characteristics as well as gold standard falls detection to further quantify the relationship between ACh and mobility in PD.

Original languageEnglish (US)
Pages (from-to)20-30
Number of pages11
JournalParkinsonism and Related Disorders
StatePublished - Jun 2019


  • Acetylcholine
  • Balance
  • Falls
  • Gait
  • Parkinson's disease

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology


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